Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Int J Environ Res Public Health. 2020 Jun 30;17(13):4712. doi: 10.3390/ijerph17134712.
The effectiveness of antenatal intervention in women with increasing obesity is unknown. This study investigated whether there was a differential effect of antenatal intervention on diet, physical activity and pregnancy outcomes in women stratified by obesity class using data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) ( = 1555). The stratification was by World Health Organization classifications: Class I, II and III (30-34.9 kg/m, 35-39.9 kg/m and ≥40 kg/m). Using linear and logistic regression, adjusted for confounders, outcomes were assessed post-intervention (27-28 weeks' gestation) and in late pregnancy (34-36 weeks' gestation). Interactions between obesity class and the intervention were explored. Compared to the standard care arm, class III intervention women had lower gestational weight gain (GWG) (-1.87 kg; 95% CI -3.29 to -0.47, = 0.009), and the effect of the intervention was greater in class III compared to class I, by -2.01 kg (95% CI -3.45 to -0.57, = 0.006). Class I and II intervention women reported significantly lower dietary glycaemic load and saturated fat intake across their pregnancy. This differential effect of the intervention suggests antenatal interventions for women with obesity should stratify outcomes by obesity severity. This would inform evidence-based antenatal strategies for high-risk groups, including women with a BMI ≥ 40 kg/m.
产前干预对肥胖程度不断增加的女性的效果尚不清楚。本研究使用英国妊娠改善饮食和活动试验（UPBEAT）（n=1555）的数据，调查了产前干预对肥胖程度分层的女性的饮食、身体活动和妊娠结局是否存在差异。分层采用世界卫生组织分类：I 类、II 类和 III 类（30-34.9kg/m、35-39.9kg/m 和≥40kg/m）。使用线性和逻辑回归，在调整混杂因素后，在干预后（27-28 周妊娠）和妊娠晚期（34-36 周妊娠）评估结局。探讨了肥胖程度分层与干预之间的相互作用。与标准护理组相比，III 类干预组女性的妊娠期体重增加（GWG）较低（-1.87kg；95%CI-3.29 至-0.47， =0.009），且与 I 类相比，III 类的干预效果更大，为-2.01kg（95%CI-3.45 至-0.57， =0.006）。I 类和 II 类干预组女性在整个孕期的膳食血糖负荷和饱和脂肪摄入量显著降低。干预的这种差异效应表明，针对肥胖女性的产前干预应根据肥胖严重程度分层结局。这将为高风险人群（包括 BMI≥40kg/m 的女性）提供基于证据的产前策略。
